Need a Lab List

I had a baseline draw done the month before surgery, but unfortunately, I've only had 2 drawn since then & the last one was Jan 2010.

I know that's irresponsible and not good, but it was a money issue that couldn't be helped.  When I got back from STD after surgery, I was told that they had decided to eliminate my job & I went on unemployment & had COBRA health insurance.  Fine.  I had labs drawn in Sep '09, insurance paid them.  I had labs drawn in Jan '10 & insurance refused to pay no matter how it was submitted, stating that they knew I had them drawn b/c I needed to monitor my vitamin levels, which was the result of an uncovered service (they wouldn't cover the DS & I went to Mexico).  I ended up paying for all of them.  I then couldn't keep my coverage & it ended in May '10.  My unemployment ended in May '10.  I picked up a part-time waitress job while I continued to look for a job using my degree.  I then had appendicitis/bowel obstruction surgery with no health insurance in August '10, for which I still am paying on (& that's after 70% was written off).  I have FINALLY gotten a job with benefits & have health insurance as of 5/1/11.  Sooooo, it couldn't be helped.  The only positive thing I can say about this all is that I have always whipped out my credit card to buy vitamins & I spend just over $100/ month on them.  Now, it's time to get my levels checked.

I know when I had them checked with my doctor, he argued with me that there wasn't a Vitamin K test & that I needed to use my prothromin time.  He also argued with me that the only Iron test was Ferritin.  I know I need a % saturation.

Since I will be seeing a new doctor who has never had a DS patient & it's been so long since I had labs drawn, I thought it best just to ask someone to post a comprehensive list of all lab tests I should get run with the CPT codes so that they can look it up if they don't know what I'm talking about like last time.

I also got a baseline DEXA body scan done.  I should get another one done since it's been over 2 yrs since surgery, yes?  How do people code for it to make sure it gets paid?

Thanks!

Here's the link to the lab spreadsheet, just in case you don't have it.
Here's the link to the labs we should be running each time.

Thank you, Marci!!

I know you did the best you could with your financial situation at the time, the past is gone.  now that you have insurance get the lab work you need. I will try to answer all your question without being too long.

since you had surgery in 2009, recommendations for lab work is every 6-12 months unless you are having issues.  for the first 12-18 months lab work is monitored more frequently, at about 3-6 month intervals, to test the adaptive property of the small intestine. (intestinal adaptation-physiologial changes to the remaining portion of the small intestine that occur to increase absorptive capacity)  What assays to order should be made by a physicain with expertise in nutritional and metabolic medicine AND who can interpret and treat the assay results.  beause uless someone can do something about those results, essentially they are worthless. 

the dr that argued with you saying that there was no Vit K1 is uneducated in lab assays, and it is not surprising.  If you use your PT to monitor your Vit K, it is not "sensitive" enough.  As a DSer you should have a Vit K1 to monitor your potential Vit K deficiency.  The PT is valuable, but the Vit K1 is a much better assay for potential Vit K1 deficiencies.

Ferritin provides an accurate picture of how much iron you have in reserves.  TIBC measures the amount of transferrin (blood protein that transports iron from the gut to the cells that use it)  your body makes transferring in realtionship to your need for iron; when iron stores are low, transferrin levels increase, while transferring is low when there is too much iron.  I think you need more than just a ferritin

If it has been more than  2 years since you had a DEXA new research recommendations (per AACE)  it should be performed annually to monitor bone density.  to get this paid can be governed by your insurance co, some have stipuations as to how often they will pay for request, if you do not fit the requirments, post menopause, prior hip fracture, etc  that does not mean you follow it, being a DSer you would appeal that decision based on peer reviewed journals etc. 

I think there is a lot of confusion as to what a CPT code is.  It is a number assigned by the AMA  used by insurance co to determine benefits.  For example if you had a Vit K1 and your md put in a cpt code for routine blood work for physical that would be denied as that is not a reason to have a Vit K1, inother words it was coded incorrectly.  For a DSer there are a few CPT codes that can be used for us, some are 262, 263.9, 269.2, 263.8 etc,

hope that answered at least some of your questions

That definitely helps, thank you for all of that.  I actually did have a hairline fracture in my hip as a teen - maybe lucky me? :)

I've been worried that I'm low in iron.  I recently switched my iron form to a more aggressive/ easily absorbable, but I know I need to see the numbers to figure things out.  I'm tired a lot & get cold very easily.  My ferritin was 64 when it was last tested.  I read that it can also impact (ultimately) your blood oxygen levels.  The thing that has been puzzling me for a long time is that I feel when I am jogging that I just don't get enough oxygen or perhaps just don't have the energy to sustain it past a few minutes.  At best, I have to interval it.  But, I've taken my pulse & know that I'm always 60 - 70% of my target heart rate.  When I was obese, I actually jogged at the same pace I do now & my target heart rate was always 80% & I could sustain that for 45 min - jogged for two years every other day.  I'm hoping that will improve!

Thanks again (& any insight into iron & blood oxygen levels?)!

Not sure where the google docs link goes but Gina (majormom) had to move the ones she had for Vitalady away from google docs. She now hosts them on my server.

Here are the links:
Vitalady's Pre-Op Ideas
Labs & Target's
Distal RNY, ERNY, DS Vitamin Program
Chewable Vitamin Program
Proximal RNY Vitamin Program
Band & Sleeve Vitamin Program

Liz

Lisey,

Good luck in your new job! It's great that you have benefits.